Hypothermic Oxygenated Machine Perfusion Reduces Early Allograft Injury and Improves Post-transplant Outcomes in Extended Criteria Donation Liver Transplantation From Donation After Brain Death: Results From a Multicenter Randomized Controlled Trial (HOPE ECD-DBD).

Abstract

OBJECTIVE:

The aim of this study was to evaluate peak serum alanine aminotransferase (ALT) and postoperative clinical outcomes after hypothermic oxygenated machine perfusion (HOPE) versus static cold storage (SCS) in extended criteria donation (ECD) liver transplantation (LT) from donation after brain death (DBD).

BACKGROUND:

HOPE might improve outcomes in LT, particularly in high-risk settings such as ECD organs after DBD, but this hypothesis has not yet been tested in a randomized controlled clinical trial (RCT).

METHODS:

Between September 2017 and September 2020, 46 patients undergoing ECD-DBD LT from four centers were randomly assigned to HOPE (n = 23) or SCS (n = 23). Peak-ALT levels within 7 days following LT constituted the primary endpoint. Secondary endpoints included incidence of postoperative complications [Clavien-Dindo classification (CD), Comprehensive Complication Index (CCI)], length of intensive care- (ICU) and hospital-stay, and incidence of early allograft dysfunction (EAD).

RESULTS:

Demographics were equally distributed between both groups [donor age: 72 (IQR: 59-78) years, recipient age: 62 (IQR: 55-65) years, labMELD: 15 (IQR: 9-25), 38 male and 8 female recipients]. HOPE resulted in a 47% decrease in serum peak ALT [418 (IQR: 221-828) vs 796 (IQR: 477-1195) IU/L, P = 0.030], a significant reduction in 90-day complications [44% vs 74% CD grade ≥3, P = 0.036; 32 (IQR: 12-56) vs 52 (IQR: 35-98) CCI, P = 0.021], and shorter ICU- and hospital-stays [5 (IQR: 4-8) vs 8 (IQR: 5-18) days, P = 0.045; 20 (IQR: 16-27) vs 36 (IQR: 23-62) days, P = 0.002] compared to SCS. A trend toward reduced EAD was observed for HOPE (17% vs 35%; P = 0.314).

CONCLUSION:

This multicenter RCT demonstrates that HOPE, in comparison to SCS, significantly reduces early allograft injury and improves post-transplant outcomes in ECD-DBD liver transplantation.

• Authors: Zoltan Czigany, Johann Pratschke, Jiří Froněk, Markus Guba, Wenzel Schöning, Dimitri Aristotle Raptis, Joachim Andrassy, Matthijs Kramer, Pavel Strnad, Rene Hany Tolba, Wenjia Liu, Theresa Keller, Hannah Miller, Sandra Pavicevic, Deniz Uluk, Matej Kocik, Isabella Lurje, Christian Trautwein, Arianeb Mehrabi, Irinel Popescu, Florian Wolfgang Rudolf Vondran, Cynthia Ju, Frank Tacke, Ulf Peter Neumann, Georg Lurje
• Journal: Annals of surgery (Ann Surg) Vol. 274 Issue 5 Pg. 705-712 (11 01 2021) ISSN: 1528-1140 [Electronic] United States
• PMID: 34334635 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Topics

• Aged
• Allografts
• Equipment Design
• Europe (epidemiology)
• Female
• Graft Survival
• Humans
• Hypothermia, Induced (instrumentation)
• Incidence
• Liver Transplantation (methods)
• Male
• Middle Aged
• Organ Preservation (instrumentation)
• Perfusion (instrumentation)
• Postoperative Complications (epidemiology, prevention & control)
• Tissue Donors (supply & distribution)